Over the last decade, the issue of concussions in professional football has been addressed in books, movies, lawsuits, and significant coverage in the news media.

While nobody is fully sure of the best way to completely address the issue and minimize the risk of concussions during play and practice, the NFL instituted an important program in 2012 to become more proactive in addressing potential concussion situations during games.  The NFL began placing certified athletic trainers (ATCs) in the stadiums to view games with the purpose of looking at both the in-game contact as well as player behavior after plays and along the sidelines.

The inclusion of these healthcare professionals was a result of a hit to Browns quarterback Colton McCoy during a late season game in  December 2011 after the institution of a video review system for injuries.  The hit that McCoy took was not noticed during the game but after the game.  The NFL realized that a set of eyes were needed to review potential issues in real time.  The ATC spotters observe both the game and video feed from the broadcast coverage in real time to identify plays that may result in concussion or injury whether it is from player to player contact or contact with the ground.  The ATCs then contact either the team medical staff or the unaffiliated neurotruama consultant to advise them of what was observed.  These calls can not be handled by bench staff from the team.  The ATCs also instruct technicians to send the video of the specific incident to the sidelines for medical staff to include in their evaluation of the athlete.  According to the NFL, approximately 10 plays per game initiate this process.  ATC spotters can also initiate a medical timeout.  These timeouts are not charged to either team.

While there are several criteria for ATCs who wish to apply to this program, I think the most interesting are:

• At least 10 years experience – enough experience to really have an idea of what they are observing
• Can not have been the Head Trainer for any NFL team previously
• Can not have been employed by an NFL team in the last 20 years

I think the last two criteria that I mentioned are probably the best at showing a positive intent for this program by the NFL.  These two criteria help to minimize the impact that past relationships with teams and/or players may have on an ATC Spotters observations.

While this is a great program and the NFL appears to have done a great job in keeping the program impartial and they have empowered the ATCs with the authority to stop game play, this only addresses observational, subjective game day issues.  It still does not provide an objective and measured value to the cumulative impacts that occur during the game – or more importantly, the significant hours of practice and seasons of games that comprise a player’s career.

Helmet impact sensors like those from Shockbox may help to provide a more objective dataset to determine the amount of cumulative impacts that a player goes through during the course of games and practices.  The US military has been studying head trauma through the use of helmet sensors since 2007 and began collaborating with the NFL in 2012 to better advance the science and address the issues.

The US Army had been using helmet based sensors in Afghanistan to measure blast pressures during IED events during combat patrols.  The sensors are triggered with forces greater than 150 newtons, which is the equivalent of just under 34 pounds of force.  Not a whole lot of force when compared to the forces of between 447 pounds and 1,066 pounds in boxers when punching.  However, a drawback to the Army/DARPA program was that it was only run in combat zones and did not take into account proximity and cumulative exposure to blast pressures when firing heavy weapons. The program was ended in late 2016.

There is one five year study that was done at University of North Carolina that looked at not just game day impacts but also the hits sustained during practice sessions.  The data that they collected shows some interesting data points.  They found that some impacts that were of significant force did not cause concussions while some lesser impacts that were below “threshold” did cause concussions.  Within these below threshold concussions, they found that the area of the point of impact on the head is just as important as the amount of force.

We still have a lot to learn about the causes and effects of concussions as well as treatment post concussion (as we’ve pointed out in a Friday Five post).  But, we can take notes from the positive aspects of what the NFL has done so far with their ATC Spotter program in being more proactive in dealing with health related “workplace” issues.